Somerset Neglect Strategy

Updated: April 2021 Review date: April 2022 1

Foreword Neglect has been identified as a priority for the Somerset Safeguarding Children Partnership (SSCP) because of the serious impact it has on the long-term chances for children. The purpose of this strategy is to establish strategic aims, objectives, and priorities for Somerset in tackling neglect. It was developed by SSCP partners and applies to all agencies across all sectors working in Somerset. Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health and development. Neglect is a public health issue as well as a safeguarding issue. The impact of neglect on children can be serious, enduring and can potentially continue across their life course; neglect commonly occurs in the context of poverty and other aspects of social disadvantage, but can affect children in any social context. In Somerset, as in all four countries of the UK, neglect is the most common reason for a child to be subject of a child protection plan, so understanding its repercussions and the potential for both prevention and intervention is vital. However, neglect can be difficult to identify and respond to. It rarely manifests in a crisis that demands immediate action, it commonly occurs alongside other forms of abuse and practitioners may become accustomed to the chronic nature of neglect. An effective response therefore requires practitioners to look beyond episodes of individual parenting and understand the neglect in context; to look also at the underlying factors that can lead to neglectful experiences – including poor parental mental health, domestic violence, poverty and social disadvantage – and to consider how support and intervention will help protect against further harm and vulnerability. 2

Introduction The impact on children and young people experiencing neglect in families is enormous. Neglect causes great distress to children and young people, leading to poor health, reduced educational and social outcomes, and can be potentially fatal. Children and young people’s lives are affected and their ability to attend and attain at school can be reduced. Their emotional health and wellbeing is also often compromised and this can impact on their success in adulthood and on their ability to be successful parents in the future. Research tells us that addressing the needs of a family in an holistic way is more likely to lead to better outcomes for children, young people and their parents or carers by co-ordinating the support they receive from children, young people, adult and family services. It can be difficult to identify neglect, and research shows that it often co-exists with other forms of abuse and adversity. It is also the most common reason for child protection plans in the UK – nationally 50.5% of child protection plans on 31st March 2020 had neglect identified as a category of abuse1. In Somerset just under half (48.2%) of all child protection plans current on 31st March 2020 had neglect identified as a factor. Neglect can also be an indicator of future harm if not addressed early and effectively. Its relationship to other forms of child abuse is significant and, for some, the impact of neglect upon their development can have serious consequences as they grow older, particularly in terms of their vulnerability to further abuse and exploitation. 1 Source: Office of National Statistics (ONS) 3

Neglect is a key priority of the Somerset Safeguarding Children Partnership (SSCP) as identified in the SSCP Business Plan 2020-2021. Aims and purpose of this strategy The overarching aims of the multi-agency Neglect Strategy are: • to promote the welfare of children and young people and to improve their outcomes, • to improve practitioner understanding of neglect, and • to identify and address issues early in order to improve outcomes for children and young people. The strategy and accompanying practice guidance will enable practitioners across all agencies: • to know what neglect is, • to prevent neglect by being able to identify risk factors, and • to respond early when indicators of neglect are identified. The strategy needs to be read in conjunction with Somerset Safeguarding Children Partnership’s: • Effective Support for Children and Families in Somerset Guidance • South West Child Protection Procedures / Somerset Safeguarding Children Partnership Procedures • Resolving Professional Differences Protocol Vision for Somerset The vision for Somerset is that committed and trained professionals from a range of agencies have a shared understanding about the complexity of neglect. Supported by robust management oversight and effective supervision, professionals recognise neglect early and effectively respond in order to help and protect children and young people. Neglect by its nature is complex and difficult to address. The context of our local learning on cases of neglect reflects this importance and as such, the SSCP vision for this strategy is aligned to reinforcing the importance of these fundamentals of practice to: 4

Share Information Assess and Analyse Risk Focus on the Child and take a Whole Family approach Evidence decisions and use evidence to inform them Record their work accurately. Principles The principles underlying this strategy are that: • Children being neglected, or at risk of being neglected, must be seen, heard and helped: • Seen; in the context of their lives at home, friendship circles, health, education and public spaces (including social media). • Heard; to effectively protect children and young people, professionals need to take time to hear what children are saying and put themselves in the child or young person’s shoes and consider their lived experience. • Helped; professionals should be professionally curious and implement effective and imaginative solutions that help children and young people. Practitioners should give parents and families clear information in relation to their expectations and improvements. • Whole Family Approach: when working with a child, adult or family, practitioners should take a holistic approach and think more widely than a single service response and share concerns to support the family, identifying key partners who can contribute. • Early Identification: early recognition and identification of the signs and symptoms of neglect and recognition of the importance of effective multi-agency assessment and provision of early help. Practitioners are supported by the Effective Support for Children and Families in Somerset guidance and the Effective Support for Children and Young People with Special Educational Needs and Disabilities (SEND) and their Families in Somerset to provide “the right support, in the right place, at the right time”. 5

What is Neglect? Unless otherwise stated, the definition of neglect referred to in this guide is taken from Working Together to Safeguard Children (2018) which relates specifically to the guidance for England. It states that neglect is: “The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: • provide adequate food, clothing and shelter (including exclusion from home or abandonment); • protect a child from physical and emotional harm or danger; • ensure adequate supervision (including the use of inadequate caregivers); • ensure access to appropriate medical care or treatment; • it may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.” - HM Government, 2018. Risks See: South West Child Protection Procedures / Somerset Safeguarding Children Partnership Procedures A number of factors increase the likelihood of neglect. However, they are not predictors of neglect in themselves and therefore should be used and interpreted with care. Studies also demonstrate that in the majority of families where risk factors are found, families do not go on to neglect or abuse children (e.g. Sidebottom 2003). For example, although poverty is a risk factor, it is vitally important to remember that neglect can and does occur in affluent households where other risk factors are more relevant. 6

Families may have a combination of risk factors which could include the following: Child Risk Factors Parental Risk Factors Wider Risk Factors • Disability • Poor mental health • Poverty • Behavioural (especially maternal • Unemployment mental health difficulties) • Poor social support problems • Poor housing • Chronic ill health • Substance misuse • Families experiencing • Poor school • Domestic violence and multiple problems attendance abuse • Learning difficulties • Lack of experience of positive parenting in childhood • Young parents • Poor engagement with antenatal services If parents are feeling particularly isolated, this can make it harder for them to ask for help and increases the risk of child abuse or neglect 2; and parents who are facing complex problems such as domestic abuse or substance misuse can struggle to meet their children’s needs.3 It is common for evidence of neglect to present through signs and symptoms which may be noticed by different agencies in relation to different children in the family at different points in time. Many indicators of neglect are not difficult to recognise. Professionals may be concerned when children come to school dirty or hungry, or when they visit homes that are unhygienic or unsafe. Yet, findings from case reviews show professionals individually have concerns about a neglected child but too frequently these concerns are not shared and /or do not trigger effective action. The impact of Neglect Neglect has the potential to compromise a child’s development significantly. Because neglect frequently coexists with other forms of maltreatment, it can be difficult to disentangle its unique consequences. However, there is significant evidence to suggest that it has an adverse impact on all the seven dimensions of 2 Jütte et al, 2014 (Source: NSPCC) 3 Haynes et al, 2015 (Source: NSPCC) 7

development identified in the Assessment Framework: health, education, identity, emotional and behavioural development, family and social relationships, social presentation and self-care skills4. Neglect is particularly damaging in the first two to three years of life, if a child has little interaction with their caregiver, it can change how emotional and verbal pathways develop and impact their ability to learn - and it can continue to compromise development throughout childhood and adolescence and have consequences into adulthood and the next generations. Parents and carers need to help young children to develop gross motor skills. If they are being neglected, or if parents don’t know how to stimulate their child, this process may not happen effectively, and the child’s development may be delayed.5 Prevalence of neglect “Research suggests that 1 in 10 children in England have experienced neglect (Radford et al. 2011, Source: NSPCC (2015)). From detailed work on the available 175 SCR final reports, neglect was apparent in the lives of nearly two thirds (62%) of the children who suffered non-fatal harm, and in the lives of over half (52%) of the children who died” - Sidebotham et al, 2016. Data gathered nationally only identifies children who have experienced neglect who are already in contact with statutory services, i.e. subject to a child protection plan. The prevalence of neglect therefore is thought to be under-represented. Where children are not involved with statutory services, neglect may be overlooked, as it may be where there are numerous concerns, perhaps including other forms of abuse. 4 Tanner and Turner, 2003; Norman et al., 2012; Hildyard and Wolfe, 2002; Manly et al., 2001 5 Horwath, 2013 (Source: NSPCC) 8

The ability to benchmark the early identification of neglect with neighbouring and national authorities can be challenging, as not all safeguarding partnerships can provide data on the number of children in receipt of an Early Help Assessment where the primary concern is neglect. What do we know about the prevalence of neglect in Somerset? Neglect was the initial category of abuse for 48.2% of children in Somerset who became subject to a Child Protection plan in the year ending March 2020. Data and information about neglect in Somerset is derived from the number of children who became subject to a child protection plan where neglect is recorded as the reason for the plan. The data has limitations as Child in Need data as well as the reasons for children beginning episodes of being looked after do not currently identify neglect as a separate category from other forms of abuse. However, the local data for year ending March 2020 can be compared to rates of neglect nationally, in the South West and our statistical neighbours, as presented in the graphs below. Percentage of children becoming subject to a Child Protection plan for Neglect - year ending 31/03/2020 56.00% 55% 54.00% 52.00% 50.50% 51.10% 50.00% 48.00% 48.20% 46.00% 44.00% Somerset 2020 Statistical Neighbour England 2020 South West 2020 2020 9

Children becoming subject to a Child Protection plan for Neglect, Rate Per 10,000 - year ending 31/03/2020 25 22 22 20 19 RATE PER 10,000 15 12 10 5 0 Somerset 2020 Statistical Neighbour England 2020 South West 2020 2020 6 A complex trio of parental behaviour related to substance misuse, domestic abuse and poor mental health has highly adverse effects on dependent children. These behaviours may occur in isolation or in combination. Evidence from serious case reviews nationally, conducted under the previous Working Together to Safeguard Children (2015) legislation, shows that this complex trio of behaviours puts children at greater risk of abuse and neglect. Therefore, it is important these risk factors are identified at the earliest opportunity. Case review findings and themes “From detailed work on the available 175 SCR’s final reports, neglect was apparent in the lives of nearly two thirds (62%) of the children who suffered non-fatal harm, and in the lives of over half (52%) of the children who died.” - Sidebotham et al, 2016. Neglect is usually the most common reason for initiating child protection procedures7, and national research demonstrates it is the most common form of harm for adolescents who were the subject of a child protection plan. There has been a long-term upward trend in the proportion of older children who were the subject of a CPP as a result of neglect.8 Key findings from research9 are: 6 Rate per 10,000 calculated by dividing actual number of CPPs by 0-17 population for grouping, then multiplying by 10,000. Population is based on ONS estimate made in September 2020. 7 Source: NSPCC (2015) How safe are our children? 2015 - Indicators 8 and 14 8 Source: NSPCC (2020) How safe are our children? 2020 - How safe are adolescents? 9 Source : Brandon, M. et al. (2013) Neglect and serious case reviews: a report from the university of East Anglia commissioned by NSPCC 10

• Neglect is more prevalent in serious case reviews than had previously been understood (neglect identified in 60 per cent of the 139 reviews from 2009–2011). • Neglect can be life threatening and needs to be treated with as much urgency as other categories of maltreatment. • Neglect with the most serious outcomes is not confined to the youngest children and occurs across all ages. • The possibility that in a very small minority of cases neglect will be fatal, or cause grave harm, should be part of all practitioner’s mind set. This is not to be alarmist, nor to suggest predicting or presuming that where neglect is found the child is at risk of death. Rather, practitioners, managers, policy makers and decision makers should be discouraged from minimizing or downgrading the harm that can come from neglect and discouraged from allowing neglect cases to drift. • The key aim for the practitioner working with neglect is to ensure a healthy living environment and healthy relationships for children. Prevention and early access to help and support for children and their families are crucial, but so too is later stage help for older children who live with the consequences of longstanding neglect. Recognising and responding to neglect of older children can be challenging for professionals at any time. The Triennial Review of Serious Case Reviews 2014-1710 in England concludes that ‘adolescents living in situations of neglect may be particularly vulnerable to having their needs, and the risks they face, overlooked’.11 This has become increasingly challenging at a time when many young people’s contact with professionals, such as teachers and youth workers, has been cut off. Local historical Serious Case Review findings Serious Case Reviews have now been replaced by Child Safeguarding Practice Reviews, however, key themes identified through Serious Case Reviews under the Working Together to Safeguard Children (2015) legislation are: • Normalisation – drift in acting upon neglect for children, especially babies or very young children who may have been neglected for 100% of their lives, or application of the rule of optimism where there is long term neglect. • Compliance - families are often resistant to intervention by agencies. • Hostility - workers attempted to be flexible and accommodating in the face of verbal aggression, the balance between support and challenge was hard to maintain. 10 Complexity and challenge: a triennial analysis of SCRs 2014-2017 (publishing.service.gov.uk) 11 Brandon, M. et al (2020) Complexity and challenge: a triennial analysis of SCRs 2014-2017: final report. London: Department for Education 11

• Parents’ own issues - many parents were young and also had adverse childhood experiences such as family breakdown, abuse, living with their own parental mental health and /or parental substance misuse prior to becoming parents , inter-generational domestic abuse leading to a propensity to prioritise their own needs and leading to neglect. • Professional communication – some gaps in involving the right agencies and in information sharing. • Pre-birth Planning Protocol - pre-birth guidance was limited and there was no local protocol available at the time, although significant work has occurred within the south west region and within Somerset to address this since 2019. • Use of escalation policy – the need to encourage greater use of the SSCP Resolving Professional Differences Protocol, particularly at the lower informal levels. Strategic priorities for Somerset Safeguarding Children Partnership Strategic priorities for Somerset Safeguarding Children Partnership are to: 1. Secure collective commitment to addressing neglect across all agencies including strong multi-agency leadership, culture and systems to address neglect. 2. Strengthen and continue to embed Early Help ways of working whereby agencies work collaboratively together to identify neglect and respond early. 3. Improve the knowledge, skills and competence of practitioners to identify and respond to neglect; including a common understanding of neglect and thresholds for agency intervention. Given the interface of neglect with other forms of harm and abuse, the SSCP places this strategy in the context of other strategic plans that influence the safety and wellbeing of children and young people in Somerset. This includes explicit acknowledgement of the impact of neglect in creating the vulnerabilities that make children and young people more susceptible to exploitation in all its forms, including criminal and sexual. 12

Early Help It is paramount that the multi-agency response to neglect provides early help to children and young people and families. “Providing early help is more effective in promoting the welfare of children than reacting later. Early help means providing support as soon as a problem emerges, at any point in a child’s life, from the foundation years through to the teenage years. Early help can also prevent further problems arising; for example, if it is provided as part of a support plan where a child has returned home to their family from care, or in families where there are emerging parental mental health issues or drug and alcohol misuse.” - Working Together to Safeguard Children, 2018. 13

In its 2014 report into a number of thematic inspections, In the Child’s Time: Professional Responses to Neglect, Ofsted identified that ‘the pervasive and long- term cumulative impact of neglect on the well-being of children of all ages is well documented’. Findings from both inspections and research highlight the following areas as being key components to a successful, multi-agency response to neglect: • Early recognition and intervention. • Robust management oversight and supervision. • Specialist training. • Acknowledgement of complexity. • Effective and timely professional responses both for help and protection. • Use of tools, such as the Somerset Neglect Toolkit. The following themes, informed by the above factors, local learning and strategic priorities, provide the focus for further development of the local arrangements and responses to neglect in Somerset: Theme 1: Governance To secure collective commitment to addressing neglect across all partner agencies and to demonstrate effective leadership in driving forward the appropriate systems, culture and process changes required. The focus of this theme is a recognition of the need for all organisations to show leadership and commitment to identifying and responding to neglect, to promote a culture that encourages professional curiosity, challenge and appropriate escalation of concerns. This commitment is required from all levels and all agencies including those who are in the housing and environmental services. The SSCP will ensure arrangements monitor the effectiveness of how leaders: • Ensure their practitioners have an overview of the prevalence and type of neglect affecting children and young people in their local area. • Ensure their practitioners have a shared understanding of neglect and know what to do if they are worried about a child or a parent/carer and how to escalate concerns. • Ensure that early identification and the effective response to neglect will remain a priority across all organisations, both statutory and non-statutory. • Support effective joint working between adult and children services and across relevant strategic Partnerships/Boards; supporting a clear local partnership response to neglect that adopts a ‘Whole Family’ approach. 14

• Drive the importance of the professional networks talking with each other and sharing information appropriately in order to tackle neglect effectively. • Ensure their staff are sufficiently trained (both single and multi-agency training) to recognise and tackle neglect and are particularly alert to the risks arising for children with special needs and disabilities. • Ensure that relevant developments in service provision are promoted and clear for practitioners on a multi-agency basis. Robust management oversight and supervision • All practitioners receive effective supervision to help them test, challenge and reflect upon their analysis of risk to children and young people; particularly in the context of neglect and the cumulative indicators of harm. • Practitioners challenge each other and escalate as appropriate when there are professional differences. Theme 2: Prevention To improve the recognition, assessment and response to children, young people and families living in neglect, before statutory intervention is required, including the appropriate use of assessment tools and to empower families to respond to children’s needs. Through a focus on this theme, it is intended that there is early recognition of neglect and effective and timely responses both for help and protection. Professionals who come into contact with children and young people and families will have relevant knowledge and a common understanding of neglect between and within agencies, as this is crucial to allow effective identification and a common language. Early Recognition of Neglect • Neglect is identified and named as a concern by professionals at the earliest opportunity. Professionals know who to contact and know what will be done in response. This is supported through robust awareness raising and regular training provided by the SSCP to partner agencies. • All professionals take a whole family approach and are alert to the risk of children being neglected through exposure to domestic abuse, parental substance misuse, parental mental health issues and learning difficulties. • Staff do not normalise neglect because of poverty, there is greater awareness of ‘neglect by affluence’. 15

• Early Help ways of working effectively assess and provide timely, robust multi- agency services to prevent problems getting worse with fewer children and young people being brought up in households suffering from neglect. Effective and timely professional responses both for help and protection • All professionals are intently curious about family circumstances and undertake or facilitate home visits to check on children and young people at home. • Assessment processes take account of the needs of the whole family, promoting an approach with a genuine focus on prevention and promoting the health, safety and wellbeing of all family members. Theme 3: Intervention To demonstrate robust multi-agency working together, sharing information and an understanding of agency’s threshold of intervention whereby agencies are able to collaborate early and intervene in ways which engage the parents and take into account historical information to inform present position and the multiagency response. Through a focus on this theme, it is intended that practitioners have the correct knowledge and skills for intervention with families who may present particular challenge and resistance. • There will be an understanding of each agency’s thresholds for intervention – which will allow effective and meaningful challenge (and escalation as appropriate) concerning cases of neglect. • Families who have identified needs and require additional support are targeted/supported. • There is effective collaboration and information sharing. • Hard to engage parents do not prevent effective intervention with the child or young person. • All services consider/research historical information to inform the present position but also appreciate that circumstances may change. • Professionals are able to identify, and address vulnerabilities associated with neglect and build up families’ ability to sustain change. • There are clear processes and mechanisms to enable practitioners to assess and identify risk. • Where neglect themed assessment tools are used – these are aligned to the Effective Support guidance. 16

• Members of the community are better equipped to recognise neglect in all its forms and know how to report it. • They are also supported in understanding their responsibility to respond to neglect and their contribution to preventing neglect is acknowledged. Theme 4: Evaluation To monitor progress in reducing the risk of neglect in the population of Somerset, with a particular focus on very young children. Through a focus on this theme, it is intended that the SSCP and its partners will demonstrate the effectiveness of the strategy and its implementation through a robust, shared and jointly owned evaluation framework which measures success and impact of the three strategic priorities. The SSCP will monitor performance through the development of a clear set of outcome measures which will be determined by the Quality and Performance subgroup. SSCP, April 2021 Review date: April 2022 17